Mental Health Big Player in Obama's Gun Plan

by David Pittman David Pittman,Washington Correspondent, MedPage Today
January 16, 2013

WASHINGTON -- Mental health issues were in the spotlight Wednesday in the executive orders President Obama signed and proposals he issued for Congress, all aimed at curbing violent gun deaths.

The actions, announced in a news conference shortly before noon Wednesday, include several that focus on increasing research on gun violence while furthering access to mental healthcare, in part by widening screening and awareness and by putting mental health services on a par with physical health.

The executive orders and proposals to Congress came after a series of White House meetings with more than 220 groups -- including public health organizations and medical societies -- following the massacre at Sandy Hook Elementary School that killed 26 people on Dec. 14.

The 23 presidential actions ordered Wednesday include:

Issuing a presidential memorandum directing the CDC to research the causes and prevention of gun violence

Clarifying that the Affordable Care Act (ACA) does not prohibit doctors from asking their patients about guns in their homes

Releasing a letter to healthcare providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities

Releasing a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover

Launching a national dialogue led by Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan on mental health

About a dozen of the executive orders deal with making it easier to conduct background checks by loosening up federal bureaucracy. Included was an order to "address unnecessary legal barriers, particularly relating to the Health Insurance Portability and Accountability Act, that may prevent states from making information available to the background check system."

The proposed reforms for Congress to consider, which include wider use of background checks for purchasing guns, assault weapons bans, and improving school safety, intend to keep guns out of the wrong hands and hopefully reduce violent deaths, the White House said.

"If there's even one thing we can do to reduce this violence, if there's even one life that can be saved, then we have an obligation to try it," Obama said.

Obama asked for $15 million to train teachers and others who interact with youth on how to respond to and handle mental health issues. Less than half of children and young adults with a diagnosable mental health condition receive treatment, the president said.

His proposal also calls for training 5,000 more social workers, counselors, and psychologists with a focus on serving students and young adults.

Obama also asked for criminal background checks for all gun sales, noting that 40% of purchases are currently done without one. He also called on Congress to reinstate the ban on military-style assault weapons and high-capacity magazines.

A number of proposals aimed to make schools safer in part by providing them with the resources they need for resource officers and mental health professionals, and to make other investments in school safety.

The reforms were praised by medical groups, including the American Academy of Pediatrics (AAP), a group that had called for gun control legislation well before the Sandy Hook shooting.

"The Academy agrees with the president that to prevent future incidents like the shooting in Newtown there must be stronger gun laws, comprehensive access to mental healthcare, and no restrictions on federal gun violence research and prevention efforts," AAP President Thomas McInerny, MD, said in a statement.

Washington lawmakers must find a way to balance constitutional rights with the protection of innocent children and adults, according to Ari Brown, MD, pediatrician in Austin, Texas.

"One does not need an assault weapon to go deer hunting or even have one in the home to protect from intruders," Brown told MedPage Today in an email.

Physicians must not lose sight of the fact that children are naturally curious and adolescents naturally impulsive -- characteristics that can produce a lethal combination around guns, said Laura Jana, MD, pediatrician and author in Omaha, Neb.

"It is important for pediatricians to continue to discuss and inform families in their care about the risks of having guns in their homes," she wrote in an email to MedPage Today.

The American College of Physicians (ACP) urged Congress to pass the proposed reforms that need its action, such as the ban on assault weapons and background checks on all gun purchases.

"ACP agrees on the urgency of adoption of [these] policies ... and is committed to being part of the change outlined by the president," ACP President David Bronson, MD, said in a statement.